Reflective Journal on Ethical Issues for Case Studies

As nurses, we encounter ethical situations everyday regarding patient care. How we handle these situations promote equality while seeking rationality. After reading the two case studies presented, I will discuss in my reflective journal how the ethical issues were presented, the steps taken in the decision-making process to ethically address the issues, the lenses used and how these lenses influenced the decisions made, and also how these can relate to the workplace. The Baird Decision Model is a five step process that guides us through that decision-making process when making ethical decisions.

The steps include, being attentive to what is happening, being intelligent, reasonable, responsible, and reflective.

In the first case simulation, Rachel a sixteen year old is giving birth to her first child. The ethical issues presented are that she is a minor, parents are requesting minimal medications during delivery, and the situation could gradually worsen at any moment. The decision-making process involves deciding who is highly impacted from the outcomes of the decisions made by the parents and health care staff.

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From there, the use of the Rights/Responsibility lens were used to help make my decisions. Based on these lenses, you must recognize your duties as caregiver. We as nurses must always follow rules and policies. By advocating for the patient, accommodation of parents harming her is not the right choice. The best care possible must be given to prevent harm to Rachel or the baby. By informing the parents of any risks and benefits regarding Rachel's care, this allows them to make informative decisions.

During this process, the parents values are maintained and the patient receives effective care. By using these lenses, the nurse is also trusted to provide safe care to the patient and safe delivery for the baby without unnecessary pain.

My decision was influenced by these lenses because they help determine the value of the stakeholders and the impact it made. In my workplace, concepts from this situation would help because we encounter patients who are minors and patients who have relative with control over their plan of care, such as a POA, or power of attorney. This would guide us toward the right direction for providing safe and competent care, respecting the wishes of the patient, and preventing harm.

In the second case simulation, Allen was brought to the ER by his same sex domestic partner, Yves. The ethical issues presented are as follows, Allen has remained unconscious in ICU without a diagnosis for almost a day and Yves has been prevented from visiting him in ICU by the shift supervisor, per policy. Yves has shown minimal proof that they are actual domestic partners. The issue remains how to best assure access for gay partners of Seva's patients on equal footing with straight couples. The decision-making process involves identifying the basic rights and liberties. These rights are as follows, the right to notice or know what the rules entail, the right to voice or share concerns, and the right to have agreements honored and not change at any given moment.

The lenses used in this case are Relationship/Reputation lenses. The relationship lens establishes fairness by using authority properly. The reputation lens sorts through the problem and maintains one's basic liberties. These lenses influenced my decision because I practice fairness regardless of who you are. The best option to fulfill the requirements of both lenses for me were to leave a note on Allen's chart that the policy was not being followed and Yves is getting access to visit Allen. We have to be careful because there is a thin line that could easily cross over into discrimination which cases regarding same sex couples. We would want to maintain our integrity with the community in regards to similar situations but also abide by the law concerning release of patient information. The concepts in this simulation relate to the workplace every day.

As we take care of our patients, visitors come and go around the clock. Many visitors inquire about the patient's status. It is our duty to provide safe care and preserve the patient's right to privacy. HIPAA is governed by state laws. It is a privacy regulation that ensures the safety and confidentiality of health information. As I encourage visitation, I also remind visitors of patient privacy regarding their health records. So as we continue taking care of patients, we must handle diversity, represent company values, and practice fairness.

References

1. What is HIPAA?. (2012). Retrieved from http://www.dhcs.ca.gov